Vertebral spondylitis is difficult to diagnose andis often treated as fever of unknown origin. Weencountered a 46-year-old man with complaints offever and back pain. He had costovertebral angletenderness on percussion and elevated inflammatorymarkers on blood biochemistry; he was suspected tohave urinary tract infection. A likely cause of fever,such as pyelonephritis, was elusive on non-contrastchest/abdomen/pelvis computed tomography and subsequentcontrast computed tomography and magneticresonance imaging. Specialist radiology review wassuggestive of vertebral spondylitis. Physical reexaminationrevealed numbness and muscle weakness consistentwith the location of the lesions. Conservativeantibiotic treatment was initiated. Septic right kneejoint was also suspected, and arthroscopic washoutwith débridement was urgently performed. Inflammatorymarkers improved on conservative antibiotictreatment. In emergency settings, thorough physicalexamination and coordination between medical specialistsis crucial.